Sleep and neurocognitive functioning in children with eczema

Abstract

Sleep disruption in childhood is associated with clearly defined deficits in neurocognition and behaviour. Childhood eczema is also a potent cause of sleep disruption though it is unknown whether it too results in neurocognitive deficits. To test this hypothesis, neurocognitive (WISC-IV), parental-reported sleep quality (Sleep Disturbance Scale of Children (SDSC)) and overnight polysomnographic (PSG) data were collected in 21 children with eczema and 20 healthy controls (age range 6-16 years). Children with eczema had worse sleep quality on both PSG (notably increased nocturnal wakefulness, a higher number of stage shifts and a longer latency to REM onset) and parental report. In addition, they demonstrated significant neurocognitive deficits (especially verbal comprehension, perceptual reasoning and to a lesser extent working memory) with a composite Full Scale IQ 16 points lower than controls. Parental reported sleep problems but not PSG parameters were correlated with reduced neurocognitive performance. However, hierarchical regression analyses revealed that eczema status was predictive while sleep fragmentation (parental or PSG) was not predictive of neurocognitive performance. As this is the first study to systematically examine neurocognitive functioning in children with eczema and given the finding of significant deficits it merits replication especially given the prevalence of the condition. The unanswered question is whether these cognitive deficits normalise with effective eczema treatment and if this is mediated by improvements in sleep architecture.

Keywords: Children; ECG; EEG; EMG; EOG; Eczema; IQ; ISSAC; International Study of Asthma and Allergies in Childhood; LTE(4); NART-R; NREM; National Adult Reading Test Revised; Neurocognition; Non rapid eye movement sleep; OAHI; Obstructive Apnoea Hypopnoea Index; PSG; Polysomnography; REM; SCORAD; SDB; Scoring of Atopic Dermatitis Index; Sleep; Sleep disordered breathing; WISC-IV; Wechsler Intelligence Scale for Children; electrocardiography; electroencephalography; electromyography; electrooculography; intelligence quotient; leukotriene E(4); polysomnography; rapid eye movement sleep.